Archive for the ‘mini-posts’ category

Today was an infusion day and at the request of some of the other patients I have gotten to know I took my mandolin and played Christmas music. I know it helps me and hope it helps them; they seemed to like it. I am the first patient ever there who has played the mandolin while getting an IV infusion. I’ve always believed there is some power in the music and the others seem to agree; at least it makes a tough experience more tolerable.

The mandolin Christmas book I work out of and recommend for players of all levels is Roland White’s. It is not too difficult and yet his liberal use of rich double stops makes it sound more complicated than what it is. So, thanks Roland for your help to make a group of patients happy today. You never know where all the mandolin will take you.

I saw a patient today who said he grew up next door to Earl’s sister Ruby. He recalled one day when a long car drove up and stopped. The door opened and out stepped Earl and Lester and the Foggy Mountain boys. They sat on the front porch and picked for a few hours. The man was only six years old at the time, so it was many years ago. He said the memory was as vivid as if it’d been yesterday.

My how I’d a loved to have been there. He made my day. The man was on blood pressure medicine. We are supposed to only give out one month’s worth of samples at a time, but I gave him two. Don’t tell anybody. But I figured he deserved it, ’cause he was true bluegrass.

When I was in High School we had a Driver’s Ed instructor everyone called Puddin Head. He was the first patient I diagnosed with narcolepsy. (I was into the doctor thing early, but then it didn’t count.)

Pudd would fall asleep and I’d drive all the way to South Carolina. He usually woke up when I’d go through the Dairy Queen. He liked the Dilly Bars or whatever they called ‘em back then.

Pudd always said I was gonna be a Doctor, ’cause I aced all his tests. Of course they weren’t very difficult. He’d ask a question like: “Following too closely may result in a rear end what?”

All you had to do was write: “collision.”

Or maybe: “Look both ways when crossing the inter what?”

Answer: “section.” You get the idea.

As remarkable as it might seem, a few had to repeat. Leroy was one of them. He got thrown out of chemistry for asking if you could freeze fire. Oh well.

We sure were naive back then. We used slide rules, didn’t have computers, barely knew what splitting atoms might be, and the only terrorist we knew was King Kong. We were scared of him.

I don’t think the world will ever be the same. I am certain it will never be as simple.

A patient was in and had two letters from the same insurance company. They deemed it urgent the doctor address this problem. One letter said the company could not approve Nexium, the other asked why he was not taking it.

This is how Docs spend our time, and your insurance dollars, these days.

You might wonder why an old doctor feels compelled to write. There are very few human truths. Through writing I have found some of them. I have not seen any in the health insurance industry yet, but I’ll continue the search.

Dr. Dee had a patient with appendicitis who had pain on the left side instead of the right. He did a fine job ’cause he did not succumb to diagnostic perseveration, or D.P.

D.P. is a common error, and one that is easy to fall into. In it, you hold onto your original hypothesis at all costs. At first for all the world the patient seemed to have diverticulitis, but after a couple days it didn’t add up, and Dr. D reversed field and considered appendicitis. A CT confirmed the suspicion, and the patient did well.

In medicine what is is most of the time, but one has to keep in mind what is sometimes ain’t. At times folks don’t understand, but it is why we are very reluctant to ever assume much or diagnose over the telephone. Nothing strikes fear in me more than to have someone call and say, “well, I’m ‘pretty sure’ I have a stomach virus.” (One time when it turns out to be an aneurysm will make a believer out of you right quick.)

Knock on wood; tomorrow might be the day I have a disaster, but I have been saved more than once by not falling into diagnostic perseveration. Most of the time, I got it right ’cause I came, I saw, and I reconsidered a few times in the interview. Often it is because the patient gave me the clues that made me chunk my original theory about what was wrong.

There is an old saying in medicine: “If all else fails, ask the patient. (like reading the directions, I guess) They will usually tell you what is wrong.” That has proved true over and over for me. They might not say “I think I have scleroderma,” but they will sure enough tell you the symptoms that will lead you down the right path if you don’t forget to listen.

For Dr. Dee’s patient, it is a good thing he listened. What it is is, but it wasn’t. Thank goodness his radar was up and he was not bitten by D.P. The patient was happy about it too.

When I first started practice, I had a lady in the Emergency Room with a black widow spider bite. It was my first case of that.

I checked her out, got her out of pain first, then found an Emergency Medicine text. I opened the book to the page on black widow bites, flopped it open on the foot of the bed and commenced to follow a written protocol.

The lady was groggy from the pain medicine but said, “You reading that book makes me nervous.”

I replied, “Well, I tell you what ma’am. I believe you’d be more nervous if I wasn’t reading the book. This is my first one of these.”

I think if she hadn’t been loaded up on Morphine she mighta bolted, but she stayed and got better, though I can’t say for sure it was my treatment. Mostly it was morphine and time. Half of what I did that day is no longer in evidence based medicine vogue. (Not that what is in fashion today will be twenty years from now either.)

She didn’t much want to hear it, but I think patients and Docs both are better off for us to admit up front what we don’t know and do the best we can.

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